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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005738
Report Date: 07/24/2024
Date Signed: 07/24/2024 01:29:48 PM

Document Has Been Signed on 07/24/2024 01:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:INSPIRING CAREFACILITY NUMBER:
397005738
ADMINISTRATOR/
DIRECTOR:		PUCKETT, VICTORIAFACILITY TYPE:
735
ADDRESS:2488 NATHANIEL STREETTELEPHONE:
(209) 951-2405
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 5CENSUS: 4DATE:
07/24/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Lynette More TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kesha Lewis arrived unannounced to conduct a case management visit regarding a substantiated complaint investigation. LPA Lewis met with facility staff and explained the reason for the visit.

Based on the complaint investigation which consisted of interviews with staff and residents it was determined that the licensee failed to provide a safe environment for the residents in care. Three (3) staff members confirmed there was verbal and physical abuse toward residents. Licensee claims to be unaware of any such behavior. Administrator was not present 8 out of 8 visites made by the department in 2024,


The following deficiencies are being cited per California Code of Regulations, TITLE 22. see 809D page...

Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/24/2024 01:29 PM - It Cannot Be Edited


Created By: Kesha Lewis On 07/22/2024 at 01:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: INSPIRING CARE
FACILITY NUMBER: 397005738

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/25/2024
Section Cited
CCR
85064(e)

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The administrator shall be on the premises the number of hours necessary to manage and administer the facility in compliance with applicable law and regulation.
This is not met as evidenced by:
Based on review of the facility records and interviews, the facility designated
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The facility representative stated that an updated LIC 500 will be updated on a weekly basis to include proper dates and times when the facility designated Administrator will actually be present at this facility. A statement of correction, along with the updated LIC 500, will be completed and
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Administrator is not present for a sufficient number of hours to properly oversee and manage the day-to-day operations of this facility. This posed an immediate threat to the Health, Safety, and Personal Rights of residents in care. 8 out of 8 visits the department made in 2024 the admisstrator was not present and 5 out of 6 visits in 2023 they were not present.
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submitted into CCL by the due date.
Type B
07/25/2024
Section Cited
CCR80063(a)

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(a) The licensee, whether an individual or other entity, is accountable for the general supervision of the licensed facility, and for the establishment of policies concerning its operation. This requirement is not met as evidenced by:
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 A statement of understanding of the regulation will be provided to LPA by COB 7/25/24.
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Based on observation and interview the licensee failed to meet requirements based on the department reaching out to the licensee on 7/3/24, 7/1/24 and 6/27/24 regarding an ongoing investagation and reciving no response. Which poses a potential health, safety or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Liza King
LICENSING EVALUATOR NAME:Kesha Lewis
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2024


LIC809 (FAS) - (06/04)
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